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Anaphylaxis

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81. ASCIA Guidelines - Prevention of anaphylaxis in schools, pre-schools and childcare: 2015 update

ASCIA Guidelines - Prevention of anaphylaxis in schools, pre-schools and childcare: 2015 update POSITION PAPER ASCIA guidelines for prevention of anaphylaxis in schools, pre-schools and childcare: 2015 update Sandra Vale, 1 Jill Smith, 1 Maria Said, 2,3 Raymond James Mullins 2,4,5 and Richard Loh 2,6 1 Australasian Society of Clinical Immunology and Allergy (ASCIA), 2 ASCIA Anaphylaxis Working Party, 3 Allergy & Anaphylaxis Australia, Sydney, New South Wales, 4 Health Sciences, University (...) ,stafftrainingintherecognitionandmanagementofacuteallergicreactions,planningfor unexpected reactions (including in those not previously identi?ed as being at risk), age appropriate education of children with severe allergies and their peers, and implementation of practical strategies to reduce the risk of accidental exposure to known allergic triggers. Strategy development also needs to take into account local or regional established legislative or procedural guidelines and the possibility that the ?rst episode of anaphylaxis may occur outside the home. Food

2015 Australasian Society of Clinical Immunology and Allergy

82. Glucocorticoids for the treatment of anaphylaxis. (PubMed)

Glucocorticoids for the treatment of anaphylaxis. Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may result in death. Anaphylaxis guidelines recommend glucocorticoids for the treatment of people experiencing anaphylaxis.We sought to assess the benefits and harms of glucocorticoid treatment during episodes of anaphylaxis.In our previous version we searched the literature until September 2009. In this version we searched the Cochrane Central Register of Controlled (...) Trials (CENTRAL) (The Cochrane Library 2011, Issue 3), MEDLINE (Ovid) (1956 to September 2011), EMBASE (Ovid) (1982 to September 2011), CINAHL (EBSCOhost) (to September 2011). We also searched the UK National Research Register and websites listing ongoing trials, and contacted international experts in anaphylaxis in an attempt to locate unpublished material.We planned to include randomized and quasi-randomized controlled trials comparing glucocorticoids with any control (either placebo, adrenaline

2012 Cochrane

83. Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community. (PubMed)

Adrenaline auto-injectors for the treatment of anaphylaxis with and without cardiovascular collapse in the community. Anaphylaxis is a serious hypersensitivity reaction that is rapid in onset and may cause death. Adrenaline (epinephrine) auto-injectors are recommended as the initial, potentially life-saving treatment of choice for anaphylaxis in the community, but they are not universally available and have limitations in their use.To assess the effectiveness of adrenaline (epinephrine) auto (...) -injectors in relieving respiratory, cardiovascular, and other symptoms during episodes of anaphylaxis that occur in the community.We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE (Ovid SP) (1950 to January 2012), EMBASE (Ovid SP) (1980 to January 2012 ), CINAHL (EBSCO host) (1982 to January 2012 ), AMED (EBSCO host) (1985 to January 2012 ), LILACS, (BIREME) (1980 to January 2012 ), ISI Web of Science (1950 to January 2012 ). We

2012 Cochrane

84. Anaphylaxis in Seniors Receiving Intravenous Antibiotics in Long-Term Care: Clinical Evidence and Guidelines

Anaphylaxis in Seniors Receiving Intravenous Antibiotics in Long-Term Care: Clinical Evidence and Guidelines TITLE: Anaphylaxis in Seniors Receiving Intravenous Antibiotics in Long-Term Care: Clinical Evidence and Guidelines DATE: 30 October 2013 RESEARCH QUESTIONS 1. What is the clinical evidence regarding the occurrence of anaphylaxis in seniors receiving IV antibiotics for common acute infections in long-term care? 2. What are the evidence-based the guidelines regarding monitoring (...) and administration of IV antibiotics to seniors with common acute infections in long-term care? KEY MESSAGE No relevant technology assessment reports, systematic reviews, meta-analyses, randomized controlled trials, non-randomized studies, or evidence-based guidelines regarding the occurrence of anaphylaxis in seniors in long term care receiving IV antibiotics or the guidelines for their use were identified. METHODS A limited literature search was conducted on key resources including PubMed, Medline

2013 Canadian Agency for Drugs and Technologies in Health - Rapid Review

85. Anaphylaxis to intravenous gelatin-based solutions: a case series examining clinical features and severity. (PubMed)

Anaphylaxis to intravenous gelatin-based solutions: a case series examining clinical features and severity. The proportion of patients receiving intravenous gelatin-based colloids has increased in the last decade due to safety concerns about starch-based products. Recent research suggests hypersensitivity reactions to intravenous gelatin-based solutions occur at similar rates per administration as non-depolarising neuromuscular blocking agents such as rocuronium (6.2/100,000 administrations (...) ). There are scant published data on clinical features, diagnosis and time course of these reactions. We undertook a review of cases reported and tested at one of the UK's largest drug allergy clinics. All patients seen in the drug allergy clinic at Imperial College Healthcare NHS Trust (London, UK) with a confirmed diagnosis of anaphylaxis to gelatin-based solutions between May 2013 and May 2018 were included. We retrospectively reviewed clinical histories, skin test results and severity of reactions

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2018 Anaesthesia

86. Knowledge and attitude toward anaphylaxis during local anesthesia among dental practitioners in Chennai – a cross-sectional study (PubMed)

Knowledge and attitude toward anaphylaxis during local anesthesia among dental practitioners in Chennai – a cross-sectional study Anaphylaxis is one of the local anesthetic dental emergencies that lead to morbidity and mortality. Hence, this study aimed to assess the knowledge and attitude of dental practitioners in Chennai toward managing anaphylaxis in patients who are given local anesthesia.Seventeen questions were formulated regarding anaphylaxis reactions and its treatment. The questions (...) were given to a random selection of dentists practicing in private clinics in Chennai.Two hundred dentists responded to the questionnaire. The results indicated that the majority of the participants had knowledge of one or more symptoms relating to anaphylaxis. However, none of the participants demonstrated that they knew about all symptoms relating to anaphylaxis. The results also did not vary with age. Only 62% of the dentists surveyed were equipped with emergency kits in their clinic.The present

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2018 Clinical, cosmetic and investigational dentistry

87. Emergency Management of Anaphylaxis: A High Fidelity Interprofessional Simulation Scenario to Foster Teamwork Among Senior Nursing, Medicine, and Pharmacy Undergraduate Students (PubMed)

Emergency Management of Anaphylaxis: A High Fidelity Interprofessional Simulation Scenario to Foster Teamwork Among Senior Nursing, Medicine, and Pharmacy Undergraduate Students Nursing, medicine, and pharmacy students have limited opportunities during their undergraduate programs to learn and practice together as an interprofessional team. This has prompted faculty at Memorial University of Newfoundland to explore the use of high fidelity simulated interprofessional education (HF-IPE) to help (...) , and pharmacy students. The scenario is designed to promote an understanding of the roles of nursing, medical, and pharmaceutical professionals in an interprofessional team during the emergency management of an adult patient experiencing acute anaphylaxis. Teamwork and communication skills are emphasized, and students are provided with the opportunity to communicate and collaborate within an interprofessional healthcare team.

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2018 Cureus

88. Assessing severity of anaphylaxis: a data-driven comparison of 23 instruments (PubMed)

Assessing severity of anaphylaxis: a data-driven comparison of 23 instruments The severity of an allergic reaction can range from mild local symptoms to anaphylactic shock. To score this, a number of instruments have been developed, although heterogeneous in design and purpose. Severity scoring algorithms are therefore difficult to compare, but are frequently used beyond their initial purpose. Our objective was to compare the most used severity scoring instruments by a data-driven approach (...) on both milder reactions and anaphylaxis.All positive challenges to foods or drugs (n = 2828) including anaphylaxis (n = 616) at Odense University Hospital, Denmark from 1998 to 2016 were included and severity was scored according to Sampson5. Based on recommendations from an expert group, the symptoms and values from Sampson5 were for all reactions and anaphylaxis only translated and compared by kappa statistics with 22 instruments, ranging from 3 to 6 steps.For milder reactions

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2018 Clinical and translational allergy

89. Spinacetin Suppresses the Mast Cell Activation and Passive Cutaneous Anaphylaxis in Mouse Model (PubMed)

Spinacetin Suppresses the Mast Cell Activation and Passive Cutaneous Anaphylaxis in Mouse Model We previously reported the anti-inflammatory and anti-asthmatic activities of the extract of the Inula japonica Thunb. Aiming for discovery of a novel anti-inflammatory compound, we isolated spinacetin from the extract and investigated its in vitro and in vivo anti-inflammatory effect and the related mechanism. Effect of spinacetin on the Syk signaling pathway was studied in bone marrow-derived mast (...) cells (BMMCs), and that on the nuclear factor-κB (NF-κB) and mitogen-activated protein kinases (MAPKs) was investigated in Rat basophilic leukemia (RBL)-2H3 cells and human mast cell line (HMC-1). The in vivo anti-inflammatory activity was assessed with passive cutaneous anaphylaxis (PCA) reaction assay. Spinacetin significantly inhibited the release of histamine, and production of inflammatory mediators such as leukotriene C4 (LTC4) and interlukin-6 (IL-6) in IgE/Ag stimulated BMMCs. Analysis

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2018 Frontiers in pharmacology

90. Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis. (PubMed)

Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis. Sugammadex is used to reverse the effects of neuromuscular blocking agents in many cases of general anesthesia. However, there are several reports of anaphylaxis after its use. Skin testing is the gold standard for detecting the causative agent of anaphylaxis. However, due to the lack of validated protocols for skin testing with sugammadex, the diagnostic accuracy might be inadequate. Recently, the basophil (...) activation test (BAT) has been established as a tool to detect the causative agent of anaphylaxis with high sensitivity and specificity. However, few studies have investigated the utility of the BAT for sugammadex-induced anaphylaxis.Eight patients who presented with immediate hypersensitivity to sugammadex during general anesthesia were included in this study. We conducted skin tests to confirm the diagnosis of sugammadex-induced anaphylaxis. Twenty-one sugammadex-naive individuals who had a negative

2018 Anesthesia and Analgesia

91. Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: a large multicenter retrospective cohort study. (PubMed)

Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: a large multicenter retrospective cohort study. Few studies have investigated the incidence of anaphylaxis induced by individual or structurally similar cephalosporins. The aims of the study were to assess the incidence of cephalosporin-induced anaphylaxis and evaluate the clinical efficacy of screening skin tests.In this retrospective cohort study, we obtained information (...) on total cephalosporin use and cephalosporin-induced anaphylaxis in intravenous cephalosporin recipients in 12 general hospitals between 2013 and 2015. Cephalosporins were divided into 4 groups according to similar side-chain structures. The incidence of cephalosporin-induced anaphylaxis was assessed for each cephalosporin, cephalosporin generation, and side-chain group. To verify the efficacy of screening intradermal tests (IDT) with cephalosporin, the 12 hospitals were assigned to the intervention

2018 Allergy

92. Pediatric Anaphylaxis in the Prehospital Setting: Incidence, Characteristics, and Management. (PubMed)

Pediatric Anaphylaxis in the Prehospital Setting: Incidence, Characteristics, and Management. Although hospital presentations for pediatric anaphylaxis have been described in the literature, a minimal amount is known regarding the incidence, characteristics, and management of pediatric anaphylaxis presenting to emergency medical services (EMS).We performed a retrospective observational study of pediatrics (≤16 years) presenting to EMS in Victoria, Australia. Patients with suspected anaphylaxis (...) were included if they were treated with epinephrine before or after EMS arrival. We used descriptive statistics to compare baseline characteristics and linear regression to assess trends in incidence over time.Between July 2008 and June 2016, we identified 2,137 pediatric anaphylaxis presentations. Overall, 59% were male and 70% had pre-existing anaphylaxis. The age-adjusted incidence increased over the study period, from 11.8 presentations per 100,000 person-years in 2008-09 to 38.7 in 2015-16 (p

2018 Prehospital emergency care

93. Morphine and pholcodine-specific IgE have limited utility in the diagnosis of anaphylaxis to benzylisoquinolines. (PubMed)

Morphine and pholcodine-specific IgE have limited utility in the diagnosis of anaphylaxis to benzylisoquinolines. Investigation of immediate hypersensitivity reactions in the perioperative setting involves skin testing and measurement of specific IgE (sIgE) as standard practice. In the case of the neuromuscular blocking agents (NMBAs), the main allergenic epitopes have been shown to be substituted ammonium groups. Commercial assays are available for detection of sIgE to these epitopes using (...) morphine and pholcodine substrates but questions have been raised about the effectiveness of these assays in the diagnosis of benzylisoquinoline anaphylaxis. This study was therefore undertaken to assess the effectiveness of these assays in the diagnosis of hypersensitivity reactions to this group of NMBAs.Analysis was carried out on all available results for patients assessed at the Royal North Shore Hospital Anaesthetic Allergy Clinic during the period June 2009 to June 2016. Standardised intradermal

2018 Acta Anaesthesiologica Scandinavica

94. Prehospital Administration of Epinephrine in Pediatric Anaphylaxis - A Statewide Perspective. (PubMed)

Prehospital Administration of Epinephrine in Pediatric Anaphylaxis - A Statewide Perspective. Timely administration of epinephrine is critical in the treatment of anaphylaxis. This study sought to determine the frequency of administration of epinephrine by EMS providers caring for pediatric patients in the prehospital setting.We examined data from the NC EMS database (PreMIS) from 2010-3 to determine frequency of epinephrine administration in pediatric patients with anaphylaxis. We studied (...) patients <18 years of age with an EMS provider impression of "allergic reaction." Anaphylaxis was present if there was hypotension (defined as SBP < 90 or DBP < 45 for patients age 11 and older, and SBP < 70 + (2 × age) for patients ages 0-10), or impaired respirations (defined as description of labored or absent respirations, or RR < 12 or > 30). We determined the overall frequency of epinephrine administration. A multivariate logistic regression was then constructed to examine the impact

2018 Prehospital emergency care

95. Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis. (PubMed)

Syringe Administration of Epinephrine by Emergency Medical Technicians for Anaphylaxis. In recent years, the costs of epinephrine autoinjectors (EAIs) in the United States have risen substantially. King County Emergency Medical Services implemented the "Check and Inject" program to replace EAIs by teaching emergency medical technicians (EMTs) to manually aspirate epinephrine from a single-use 1 mg/mL epinephrine vial using a needle and syringe followed by prehospital intramuscular (...) administration of the correct adult or pediatric dose of epinephrine for anaphylaxis or serious allergic reaction. Treatment was guided by an EMT protocol that required a trigger and symptoms. We sought to determine if the "Check and Inject" program was safely implemented by EMTs treating presumed prehospital anaphylaxis or serious allergic reaction.We conducted a prospective investigation of all cases treated as part of the "Check and Inject" program from July 2014 through December 2016 in suburban King

2018 Prehospital emergency care

96. Mast Cell CRF<sub>2</sub> Suppresses Mast Cell Degranulation and Limits the Severity of Anaphylaxis and Stress-Induced Intestinal Permeability. (PubMed)

Mast Cell CRF2 Suppresses Mast Cell Degranulation and Limits the Severity of Anaphylaxis and Stress-Induced Intestinal Permeability. Psychological stress and heightened mast cell (MC) activation are linked with important immunologic disorders, including allergy, anaphylaxis, asthma, and functional bowel diseases, but the mechanisms remain poorly defined. We have previously demonstrated that activation of the corticotropin-releasing factor (CRF) system potentiates MC degranulation (...) responses during IgE-mediated anaphylaxis and psychological stress through corticotropin-releasing factor receptor subtype 1 (CRF1) expressed on MCs.In this study we investigated the role of corticotropin-releasing factor receptor subtype 2 (CRF2) as a modulator of stress-induced MC degranulation and associated disease pathophysiology.In vitro MC degranulation assays were performed with bone marrow-derived mast cells (BMMCs) derived from wild-type (WT) and CRF2-deficient (CRF2-/-) mice and RBL-2H3 MCs

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2018 Journal of Allergy and Clinical Immunology

97. Trends in the diagnosis and management of anaphylaxis in a tertiary care pediatric emergency department. (PubMed)

Trends in the diagnosis and management of anaphylaxis in a tertiary care pediatric emergency department. Underdiagnosis of anaphylaxis is a major concern in the pediatric emergency department (PED), leading to failure to administer and prescribe intramuscular epinephrine treatment.To examine the clinical features, triggers, and management of anaphylaxis in the PED, with a special focus on the rate of cases diagnosed and treated correctly over time, and to compare correctly diagnosed (...) and misdiagnosed cases.All records of patients presenting to a tertiary care PED between 2013 and 2016 with a final diagnosis of anaphylaxis or allergic reaction were reviewed.The rate of anaphylaxis increased from 0.1% between 2013 and 2014 and 0.24% between 2015 and 2016. Symptoms such as breathing difficulties and wheezing were found significantly less among misdiagnosed patients compared with patients correctly diagnosed with anaphylaxis. Food was the most common causative agent in both of the study

2018 Asthma & Immunology

98. Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). (PubMed)

Anaesthesia, surgery, and life-threatening allergic reactions: epidemiology and clinical features of perioperative anaphylaxis in the 6th National Audit Project (NAP6). Anaphylaxis during anaesthesia is a serious complication for patients and anaesthetists.The 6th National Audit Project (NAP6) on perioperative anaphylaxis collected and reviewed 266 reports of Grades 3-5 anaphylaxis over 1 yr from all NHS hospitals in the UK.The estimated incidence was ≈1:10 000 anaesthetics. Case exclusion (...) because of reporting delays or incomplete data means true incidence might be ≈70% higher. The distribution of 199 identified culprit agents included antibiotics (94), neuromuscular blocking agents (65), chlorhexidine (18), and Patent Blue dye (9). Teicoplanin comprised 12% of antibiotic exposures, but caused 38% of antibiotic-induced anaphylaxis. Eighteen patients reacted to an antibiotic test dose. Succinylcholine-induced anaphylaxis, mainly presenting with bronchospasm, was two-fold more likely than

2018 British Journal of Anaesthesia

99. Risk Factors for Multiple Epinephrine Doses in Food-Triggered Anaphylaxis in Children. (PubMed)

Risk Factors for Multiple Epinephrine Doses in Food-Triggered Anaphylaxis in Children. Food-related anaphylactic reactions may require treatment with more than 1 dose of epinephrine. Current guidelines advise patients at risk of anaphylaxis to carry 2 epinephrine autoinjectors.The objective of this study was to determine risk factors of multiple-dose epinephrine treatment in pediatric food-related anaphylaxis.Parents of children with physician-confirmed diagnosis of food allergy were (...) ratio [OR] 3.2; 95% confidence interval [CI] 1.2-8.4) and treatment with oxygen (OR 5.0, 95% CI 2.0-12.4) were significant risk factors for requiring multiple doses of epinephrine to treat an allergic reaction.This study demonstrates that treatment of anaphylaxis may require more than 1 epinephrine injection. Reactions triggered by milk or requiring treatment with oxygen are at higher risk for needing more than 1 dose of epinephrine. Families of food-allergic children should be counseled

2018 Asthma & Immunology

100. In situ simulation in the management of anaphylaxis in a pediatric emergency department. (PubMed)

In situ simulation in the management of anaphylaxis in a pediatric emergency department. Anaphylaxis is a potentially life-threatening, rapid-onset hypersensitive reaction, usually treated in the emergency department (ED). Failure to recognize anaphylaxis leads to under-treatment with epinephrine and even when correctly diagnosed, epinephrine is not always administered. In addition, often patients who are treated in the ED are not referred for allergy work-up. Simulation is a tool (...) that increases exposure to events in a safe environment, allowing trainers to develop skills without harming patients. The main purpose of our study was to determine whether in situ simulation training increases the frequency of epinephrine use. The secondary aim was to observe whether simulation modifies the number of children investigated over the years before and after the setting up of the simulation training. All patients with anaphylaxis referred to the Pediatric Emergency Department (PED) of the Anna

2018 Internal and emergency medicine

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